title: Why some children hospitalized for pneumonia do not consult with a general practitioner before the day of hospitalization.
abstract: BACKGROUND
  Early consultation in primary care may provide an opportunity for early intervention in children developing pneumonia, but little is known about why some children do not consult a general practitioner (GP) before hospitalization.
  
  
  OBJECTIVE
  To identify differences between children who consulted a GP and children who did not consult a GP before the day of hospital presentation with pneumonia or empyema.
  
  
  METHODS
  Carers of children aged six months to 16 years presenting to hospital with pneumonia or empyema completed a questionnaire, with a subset participating in an interview to identify physical, organizational and psychological barriers to consultation. Responses from those who had consulted a GP before the day of hospital presentation were compared with those who had not on a range of medical, social and environmental variables.
  
  
  RESULTS
  Fifty seven (38%) of 151 participants had not consulted a GP before the day of hospital presentation. On multivariate analysis, illness duration ≥ 3 days (odds ratio [OR] 4.36, 95% confidence interval [CI]: 1.67-11.39), prior antibiotic use (OR: 10.35, 95% CI: 2.16-49.55) and home ownership (OR: 3.17, 95% CI: 1.07-9.37) were significantly associated with early GP consultation (P < 0.05). Interviews with 28 carers whose children had not seen a GP before the day of presentation revealed that most had not considered it and/or did not think their child's initial symptoms were serious or unusual; 11 (39.3%) had considered consulting a GP but reported barriers to access.
  
  
  CONCLUSIONS
  Lack of early GP consultation was strongly associated with rapid evolution of pneumonia.
authors.affiliation: Institute of Primary Care and Public Health, School of Medicine, Cardiff University , Cardiff , UK.
authors.forename: Joanna C
authors.initials: JC
authors.lastname: Crocker
authors.forename: Meirion R
authors.initials: MR
authors.lastname: Evans
authors.forename: Colin V E
authors.initials: CV
authors.lastname: Powell
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004653:Empyema / Q000628:therapy*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000628:therapy*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors